The psychiatric implications of visible tattoos in an adult male prison population

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Abstract
Tattoos of all kinds have been found to be associated with marginal groups, antisocial behaviours and mental health problems. Little is known, however, about the subgroup with prominent tattoos on areas of the body, such as the face, which are clearly visible to others. This paper investigates associations between visible tattoos and mental disorder, substance misuse and criminality in a large group of adult male prisoners. Childhood adversity, drug and alcohol misuse, self-harm, violent behaviour and previous imprisonment were all found to be significantly associated with the presence of visible tattoos in this population. Whilst prior contact with psychiatric services was also significantly more common, no relationship existed between visible tattoos and lifetime DSM-IV mental disorder per se. Personality disorder was not found to be more prevalent in the visibly tattooed group, but a statistically significant relationship was demonstrated between visible tattoos and schizophrenia or related psychotic disorders. Therefore, we recommend caution when screening such individuals for mental disorder. At first glance the history may suggest personality disorder, but further enquiry should be undertaken to look for signs and symptoms indicating a functional psychotic disorder.

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